Shinya Motohashi

Adventitial cystic disease of the femoral vein: report of a case.

Adventitial cystic disease (ACD) of the veins is a rare phenomenon, and ACD of the femoral vein is particularly difficult to diagnose due to the similarity in symptoms to those of deep vein thrombosis. We report a case of ACD of the femoral vein, which was initially misdiagnosed as deep vein thrombosis, in a 48-year-old woman who presented with a painless swelling in her right lower leg. The extensive cystic involvement of the femoral vein was completely resected and reconstructed with an 8-mm ringed polytetrafluoroethylene vascular graft with good results.

Coated prostheses are associated with prolonged inflammation in aortic surgery: a cost analysis.

This prospective study was conducted to compare inflammatory responses between patients receiving coated and uncoated vascular prostheses, and to examine their effect on length of stay and cost of patients undergoing abdominal aortic aneurysmectomy. Patients undergoing elective vascular reconstruction of an abdominal aortic aneurysm were assigned randomly to coated-graft or uncoated-graft groups (n = 20, for each group). Interleukin (IL)-6, granulocyte elastase, white blood cell count, C-reactive protein (CRP), and body temperature (BT) were prospectively recorded preoperatively and on postoperative days (PODs) 1, 3, 7, and 14. In-hospital stay and hospitalized costs were also analyzed. IL-6 and CRP concentrations in the coated-graft group were higher than those in the uncoated-graft group (P = 0.01 and 0.05). BT was more frequently elevated >37 degrees C at POD 14 in the coated-graft group than in the uncoated-graft group (P =0.03). Discharge was delayed, and overall hospitalization cost was higher in the coated-graft group than in the uncoated group (17.6 vs. 13.5 days, and 2 010 000 vs. 1 780 000 yen, P = 0.006 and P = 0.002, respectively). Coated vascular prosthesis demonstrated more profound inflammatory reaction than noncoated prosthesis, postoperatively.

Treatment of Abdominal Malignancy Invading the Vena Cava: A Report of Seven Cases

Retroperitoneal tumors and other abdominal malignancies invading the inferior vena cava can be treated surgically when no metastases are present. We resected four retroperitoneal tumors, two renal cell carcinomas, and one gastrointestinal stromal tumor with a concomitant caval resection. Although meticulous care is required when manipulating the major vessels, long-term survival with an improvement in the quality of life was achieved. These cases are described, with particular focus on the management of the major vessels.

Paroxysmal nocturnal hemoglobinuria: complete resolution of an occluding inferior vena caval thrombus

Paroxysmal nocturnal hemoglobinuria is a rare acquired autoimmune disease, and is frequently associated with venous thrombosis. A patient who developed thrombotic occlusion of the inferior vena cava is described. Treatment with heparin and urokinase, followed by oral anticoagulant, was effective in resolving abdominal symptoms. The venous thrombosis resolved completely, but the patient died during treatment of aplastic anemia.

Surgical techniques for implanting implantable cardioverter defibrillators in children and infants

Implantable cardioverter defibrillators (ICDs) are now being used in children. ICDs can be used to prevent sudden cardiac death caused by not only congenital heart defects, but also various non-structural diseases, such as long QT syndrome. However, a standard implantation technique for children, especially infants, has not yet been established. As the surgical implantation in infants is not amenable to transvenous lead placement, it was necessary to choose from epicardial, subcutaneous and pericardial ICD systems. However, many of these systems are associated with high rates of late complications. Lead fracture, insulation breakage, migration, buckling or crinkling of the patch lead and constrictive pericarditis have been reported as the most common lead-related complications. An increase in the defibrillation threshold is another issue that must be considered when using an ICD in a child or infant. Further studies on the outcomes, psychosomatic impact and other specific complications in the pediatric population need to be considered. The clinical use of ICDs in infants is still limited. Therefore, it is important to have many surgical options available so that the treatment can be custom-tailored to suit individual patients.

Surgical Treatment of a Patient with Aorto-pulmonary Fistula due to Thoracic Aortic Aneurysm Rupture Associated with Gastric Carcinoma.

胃癌の精査中に胸部下行大動脈瘤破裂, 肺穿破をきたし, 緊急手術により救命できた症例を報告する. 症例は57歳男性で, 近医で胃癌の精査中に喀血し, 胸部下行大動脈瘤の肺内破裂と診断された. Computed tomography (CT) では上記と肝内結石の存在も判明した. 緊急手術で胸部下行大動脈人工血管置換, 左肺下葉切除を行い, 気管支断端と人工血管を大網にて纏絡した. 大動脈遮断の補助手段には一時バイパス法を用い, ヘパリンは使用しなかった. 胸水中に Bacteroides が検出されたが順調に経過し, 約6週間後に胃亜全摘術, 肝外側区域切除, 総胆管結石除去術を行った. 患者は無事退院したが, 癌胎児性抗原 (CEA) の上昇があり, 胃癌の再発を疑い精査中である. 本例は肺内破裂で人工血管の感染予防対策が必要であったが, 進行胃癌合併例における大網纏絡はジレンマであり, 教訓的な症例であった.